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Situation Monitoring “Attention to detail is one of the most important details...” –Author Unknown ®

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Presentation on theme: "Situation Monitoring “Attention to detail is one of the most important details...” –Author Unknown ®"— Presentation transcript:

1 Situation Monitoring “Attention to detail is one of the most important details...” –Author Unknown ®

2 T EAM STEPPS 05.2 Mod Page 2 Situation Monitoring ® 2 Objectives Define situation monitoring Define cross-monitoring Discuss the components of the STEP process Define situation awareness (SA), and identify conditions that undermine SA Discuss the importance of a shared mental model Discuss when to share information Recognize the barriers, tools, strategies, and outcomes of situation monitoring

3 T EAM STEPPS 05.2 Mod Page 3 Situation Monitoring ® 3 Scenario Mary, a nursing home resident, falls while attempting to ambulate independently. She suffers a head laceration and a possible fractured hip. The nursing assistant, charge nurse, and supervisor all respond to Mary’s call for help. Diane, the supervisor, completes her assessment. She directs Ann, the nursing assistant, to retrieve 4x4 gauze from the treatment cart and Jerri, the charge nurse, to maintain c-spine precautions until EMS arrives. Noticing her confused expression, Diane tells Jerri, “Place one hand on each side of Mary’s head and keep it in straight alignment with her spine.”

4 T EAM STEPPS 05.2 Mod Page 4 Situation Monitoring ® 4

5 T EAM STEPPS 05.2 Mod Page 5 Situation Monitoring ® 5 A Continuous Process Situation Monitoring (Individual Skill) Situation Awareness (Individual Outcome) Shared Mental Model (Team Outcome)

6 T EAM STEPPS 05.2 Mod Page 6 Situation Monitoring ® 6 Process of actively scanning behaviors and actions to assess elements of the situation or environment Fosters mutual respect and team accountability Provides safety net for team and resident Includes cross-monitoring Situation Monitoring (Individual Skill) …Remember, engage the resident whenever possible.

7 T EAM STEPPS 05.2 Mod Page 7 Situation Monitoring ® 7 Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors Mechanism to help maintain accurate situation awareness Way of “watching each other’s back” Ability of team members to monitor each other’s task execution and give feedback during task execution Cross-Monitoring is… Mutual performance monitoring has been shown to be an important team competency. (McIntyre and Salas, 1995)

8 T EAM STEPPS 05.2 Mod Page 8 Situation Monitoring ® 8 Cross-Monitoring Hi, I’m here to change the dressing on your buttock. That resident has C diff. The treatment nurse should be wearing precaution gear. Should I say something?

9 T EAM STEPPS 05.2 Mod Page 9 Situation Monitoring ® 9 Components of Situation Monitoring:

10 T EAM STEPPS 05.2 Mod Page 10 Situation Monitoring ® 10 Status of the Resident  Resident History  Vital Signs  Medications  Physical Exam  Plan of Care  Psychosocial Condition

11 T EAM STEPPS 05.2 Mod Page 11 Situation Monitoring ® 11  Fatigue  Workload  Task Performance  Skill Level  Stress Level Team Members

12 T EAM STEPPS 05.2 Mod Page 12 Situation Monitoring ® 12 I=Illness M=Medication S=Stress A=Alcohol and Drugs F=Fatigue E=Eating and Elimination An individual team member’s responsibility … I’M SAFE Checklist

13 T EAM STEPPS 05.2 Mod Page 13 Situation Monitoring ® 13  Facility Information  Administrative Information  Human Resources  Acuity of Residents and Team Members’ Assignments  Equipment Environment

14 T EAM STEPPS 05.2 Mod Page 14 Situation Monitoring ® 14  Status of team’s resident(s)?  Goal of team?  Tasks/actions that are completed or that need to be done?  Plan still appropriate? Progress Toward Goal

15 T EAM STEPPS 05.2 Mod Page 15 Situation Monitoring ® 15 Situation Monitoring Recollect examples of situation monitoring, in which you needed to— Be aware of what was going on Prioritize and focus on different elements of the situation Share this information with others Select one or two that best represent the concept of situation monitoring Share

16 T EAM STEPPS 05.2 Mod Page 16 Situation Monitoring ® 16 Knowing the status of a particular event Knowing the status of the team’s residents Understanding the operational issues affecting the team Maintaining mindfulness The state of knowing the current conditions affecting the team’s work Situation Awareness is…

17 T EAM STEPPS 05.2 Mod Page 17 Situation Monitoring ® 17 Conditions That Undermine Situation Awareness (SA) Failure to— Share information with the team Request information from others Direct information to specific team members Include resident or family in communication Use resources fully (e.g., status board, automation) Document

18 T EAM STEPPS 05.2 Mod Page 18 Situation Monitoring ® 18 A Shared Mental Model is… The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. “Teams that perform well hold shared mental models.” (Rouse, Cannon-Bowers, and Salas, 1992)

19 T EAM STEPPS 05.2 Mod Page 19 Situation Monitoring ® 19 Shared Mental Model?

20 T EAM STEPPS 05.2 Mod Page 20 Situation Monitoring ® 20 Practical Exercise Gloria Valdez New admission 87 years old Dementia diagnosis Confused, anxious since admission Involved daughter

21 T EAM STEPPS 05.2 Mod Page 21 Situation Monitoring ® 21 Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page” Foster communication to ensure care is synchronized Ensure that everyone on the team has a picture of what it should look like Enable team members to predict and anticipate better Create commonality of effort and purpose How Shared Mental Models Help Teams “Shared mental models help teams avoid errors that place patients at risk.”

22 T EAM STEPPS 05.2 Mod Page 22 Situation Monitoring ® 22 What Do You See?

23 T EAM STEPPS 05.2 Mod Page 23 Situation Monitoring ® 23 Briefs Huddles Debriefs Transitions in Care When To Share?... Share information as soon as possible when a change occurs in the resident’s status.

24 T EAM STEPPS 05.2 Mod Page 24 Situation Monitoring ® 24 TOOLS and STRATEGIES Brief Huddle Debrief OUTCOMES Situation Awareness Shared Mental Model Adaptability Team Orientation Mutual Trust BARRIERS Hierarchical Culture Lack of Resources or Information Ineffective Communication Conflict Time Distractions Workload Fatigue Misinterpretation of Data Failure To Share Information Situation Monitoring STEP Cross- Monitoring

25 T EAM STEPPS 05.2 Mod Page 25 Situation Monitoring ® 25 Teamwork Actions Conduct team exercises to increase situation monitoring skills Share information in a timely fashion Include resident and/or family in communication Use cross-monitoring Apply the STEP process when monitoring the situation Foster communication to ensure that all members of the team have a shared mental model Share information during briefs, team huddles, debriefs, and transitions in care “Teams do not seek consensus; they seek the best answer.” – Katzenbach and Smith


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